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2016 Rural Provider Leadership
Summit Report
Strategies for Rural Provider
Engagement in Transitioning to
Value-based Purchasing and
Population Health
August 10, 2016
525 South Lake Avenue, Suite 320 │ Duluth, Minnesota 55802
(218) 727-9390 │ [email protected]
Get to know us better at ruralcenter.org
This is a publication of the Technical Assistance and Services Center (TASC), a program of the
National Rural Health Resource Center. This project is supported by the Health Resources and
Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)
under grant number UB1RH24206, Information Services to Rural Hospital Flexibility Program
Grantees, $957,510 (0% financed with nongovernmental sources). This information or content and
conclusions are those of the author and should not be construed as the official position or policy of,
nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
NATIONAL RURAL HEALTH RESOURCE CENTER 1
This report was prepared by:
National Rural Health Resource Center
525 S Lake Ave, Suite 320
Duluth, Minnesota 55802
Phone: 218-727-9390
www.ruralcenter.org
and
Karla Weng, MPH, CPHQ
Senior Program Manager
Stratis Health
2901 Metro Drive, Suite 400
Bloomington, MN 55425
952-853-8570
ruralhealthvalue.org
NATIONAL RURAL HEALTH RESOURCE CENTER 2
PREFACE
With the support of the Federal Office of Rural Health Policy (FORHP), the National
Rural Health Resource Center (The Center) developed this report to assist rural
hospital leaders in engaging rural health providers in the transition to value-based
purchasing and population health. This report is designed to help rural hospitals
leaders and providers during the transition. First, the report describes issues and
opportunities related to engaging rural providers in value models. Second, it
provides key strategies that rural hospitals may deploy to overcome challenges and
engage providers in value-based models and enhance medical staff collaboration.
Third, the report highlights success stories and lessons learned that were shared by
the panelists during the summit. The report is also intended to assist state Medicare
Rural Hospital Flexibility (Flex) Programs and State Offices of Rural Health (SORH)
by offering timely information to develop tools and educational resources that
support their hospitals and networks as they transition to population health.
The information presented in this paper is intended to provide the reader with
general guidance. The materials do not constitute, and should not be treated as,
professional advice regarding the use of any particular technique or the
consequences associated with any technique. Every effort has been made to assure
the accuracy of these materials. The Center and the authors do not assume
responsibility for any individual's reliance upon the written or oral information
provided in this guide. Readers and users should independently verify all
statements made before applying them to a particular fact situation, and should
independently determine the correctness of any particular planning technique
before recommending the technique to a client or implementing it on a client's
behalf.
NATIONAL RURAL HEALTH RESOURCE CENTER 3
TABLE OF CONTENTS
Introduction ......................................................................................... 4
Purpose and Process ............................................................................. 5
Rural Provider Leadership Summit Attendees ........................................... 6
Frameworks to Support Rural Provider Leadership .................................... 7
Rural Provider Engagement Strategies to Transition to value .................... 10
Rural Examples of Transition to Value ................................................... 14
Rural Provider Leadership: Tools and Resources ..................................... 16
Conclusion ......................................................................................... 16
Appendix A: Summit Participants .......................................................... 17
Appendix B: Rural Provider Leadership Tools and Resources ...................... 1
NATIONAL RURAL HEALTH RESOURCE CENTER 4
INTRODUCTION
The landscape of health care delivery and payment has been undergoing change at
a rapid pace. In early 2015, the US Department of Health and Human Services
(HHS) announced bold goals for moving payment of health care services to models
based on quality and value. The goals aim for 90 percent of fee-for-service
Medicare payments to be linked to value by 2018, and HHS has worked to develop
a private public partnership with private payers, health plans and Medicaid
programs to move in the same direction with payment connected to quality and
population health.1
Emerging payment models such as accountable care organizations (ACOs), patient
centered medical homes (PCMH) and the new provider Quality Payment Program
(QPP), place primary care providers at the center of reimbursement structures.
Payment under these models is linked to the provision of lower cost and higher
quality care. It is crucial for any health care organization to engage providers who
are engaged in quality improvement and redesigning care delivery for efficiency and
effectiveness.
Rural health care organizations, in particular critical access hospitals (CAHs), rural
health clinics (RHCs) and federally qualified health centers (FQHCs) may be
distinctly challenged by delivery and payment reform. The cost-based payment
structures for these organizations, which have been so important to preserving
access in many rural communities, do not align with the new fee-for-service based
quality and value incentive programs. This misalignment of incentives, paired with
tight resources, workforce challenges and communities that are often poorer, sicker
and older, leaves rural health care organizations and the communities they serve at
risk of being left behind.
Rural hospitals are facing unprecedented changes and challenges. More than 70
rural hospitals have closed since 20102, and another 600-plus are at risk of
closure.3 Cuts to traditional Medicare and Medicaid reimbursement, increased
reporting requirements related to quality, use of electronic records and new
payment models that deemphasize inpatient care have rural challenged the
financial viability of many rural hospitals.
During a time when rural provider input and leadership is critical to rural health
system survival and success, there are increasingly high rates of frustration and
burn-out among health care providers. For purposes of the Summit and this
1 CMS Fact Sheet on Better Care. Smarter Spending. Healthier People: Paying Providers for
Value, Not Volume. 2 NC Rural Health Research Program: 76 Rural Hospital Closures: January 2010 – Present 3 Ivantage Health: Rural Hospital Closures Predicted to Escalate
NATIONAL RURAL HEALTH RESOURCE CENTER 5
summary, ‘provider’ is defined as clinicians providing direct health care services -
such as physicians, advance practice nurses, paramedics or physician assistants.
Providers who are feeling effects of burn-out, including a loss of enthusiasm for
work, feelings of cynicism, and a low sense of personal accomplishment4 are
unlikely to be effective and engaged leaders. These factors have led to the concept
of a ‘quadruple’ aim, where improving the work life of health care providers is
aligned with the more traditional ‘triple aim’ focusing on quality, patient experience,
and lower cost.5 When crafting and implementing strategies to engage rural
providers, health care leaders need to be mindful of the stressors and challenges
already in place, and aim to be part of the solution in improving work-life of care
providers rather than adding an additional layer of requests and frustration.
PURPOSE AND PROCESS
As part of the 2016 work plan, the Technical Assistance and Services Center (TASC)
for the Flex Program, a program of the National Rural Health Resource Center (The
Center), hosted a Rural Provider Leadership Summit in Bloomington, Minnesota on
May 23 – 24, 2016. The purpose of the Summit was to identify strategies for rural
provider engagement in transitioning to value-based reimbursement systems.
The objectives for the two half-days of facilitated conversation focused on:
Identifying issues and challenges related to engaging rural providers in value
models
Identifying and prioritizing strategies and actions rural hospitals can take for
engaging rural providers in value and population health initiatives and
enhancing medical staff collaboration
Sharing examples of successful models and identifying resources to support
implementation
4 Shanafelt TD, Boone S, Tan L, et al. Burnout and satisfaction with work-life balance among
US physicians relative to the general US population. Arch Intern Med. 2012;172(18):1377–
1385.
5 Bodenheimer T, Sinsky C. From triple to quadruple aim: care of the patient requires care
of the provider. Ann Fam Med 2014; 12:573–6. doi:10.1370/afm.1713
NATIONAL RURAL HEALTH RESOURCE CENTER 6
RURAL PROVIDER LEADERSHIP SUMMIT ATTENDEES
The Summit participants, included representatives of critical access hospitals, rural
ACOs, physicians, state Flex Programs, SORHs, universities, quality and rural health
network leaders. The panel also included representatives from FORHP, a rural
foundation, emergency medical services and community paramedics. The 2016
Rural Provider Leadership Summit participants include the following field experts
(Refer to Appendix A for contact information).
John Barnas, Michigan Center for Rural Health
Barbara Berner, University of Alaska Anchorage, School of Nursing
Ray Christensen, MD, University of Minnesota Duluth, Gateway Family
Health Clinic
Morgan Fowler, Marcum & Wallace Memorial Hospital
Kathy Johnson, Dynamic Advantage
Paul Kleeberg, MD, Aledade
Paul Krause, MD, Caravan Health/National Rural Accountable Care
Organization (ACO)
Leslie Marsh, Lexington Regional Medical Center
Joe Mattern, MD, Washington Rural Health Collaborative, Jefferson
Healthcare
Mike McNeely, Health Resources and Services Administration, Federal
Office of Rural Health Policy
Melinda Merrell, South Carolina Office of Rural Health
Toniann Richard, Health Care Collaborative of Rural Missouri
Maggie Sauer, Foundation for Health Leadership and Innovation
Karla Weng, Stratis Health
Gary Wingrove, Mayo Clinic Medical Transport
Summit Facilitators
Sally Buck, The Center
Tracy Morton, The Center
Kami Norland, The Center
NATIONAL RURAL HEALTH RESOURCE CENTER 7
FRAMEWORKS TO SUPPORT RURAL PROVIDER LEADERSHIP
To help set the stage for the discussion, Summit participants reviewed two
frameworks related to identification and implementation of strategies:
1) The Performance Excellence Blueprint, a system-based approach modeled
after the Baldrige Framework for Performance Excellence
2) A resource from Rural Health Value: “Physician Engagement – A Primer for
Healthcare Leaders”
The Center has long encouraged adoption of a systems-based approach modeled
after the Baldrige Framework for Performance Excellence in managing hospital
complexities and striving towards excellence in quality and safety. The Performance
Excellence (PE) Blueprint provides a proven approach towards managing the crucial
elements of organizational excellence desperately needed in this rapidly changing
health care environment. This comprehensive approach, which includes the ability
to measure and show value, can also help hospitals frame the essential components
of provider engagement. The PE Blueprint outlines seven key areas for rural
providers to consider when developing a strategic plan for provider engagement.
The seven categories include the following.
Leadership
Strategic planning
Community, customers and population health
Workforce
Impact and outcomes
Processes for improved
Measurement, feedback and knowledge management
The seven categories in the Blueprint are not separate, but rather are
interdependent. Figure 1 demonstrates the key inter-linked components of the PE
Blueprint and how the seven components are intertwined to impact the quality of
care, financial performance and overall operations.
NATIONAL RURAL HEALTH RESOURCE CENTER 8
Figure 1.
Performance Excellence Blueprint
Modified from Baldrige Framework
The PE Blueprint enables organizations to measure predicted outcomes. Results in
all seven categories are measured regularly, and the information is fed back to
hospital leaders for ongoing improvement. Generally rural hospitals are not short of
information; rather they have so much information they often struggle to sort the
important strategic information from the less important.
The Physician Engagement Primer, developed by Dr. Clint MacKinney, part of the
Rural Health Value team at the RURPI (Rural Policy Research Institute) Center for
Rural Health Policy Analysis, identifies key categories of organizational culture
related to physician engagement: governance, education, compensation and use of
data. The primer also identifies specific tactics leaders of health care organizations
should consider to improve physician engagement including development of a
shared vision, nurturing of physician leaders, identifying effective communication
strategies and structuring meetings and discussions to promote active physician
involvement.
Throughout the Summit discussion, participants paused and referenced these two
frameworks as a touchpoint to help ensure key areas had not been overlooked.
NATIONAL RURAL HEALTH RESOURCE CENTER 9
MARKET DRIVING FORCES AND TRANSITION CHALLENGES
As rural hospitals move into value-based models and begin developing population
health strategies, there are a number of events that have happened recently that
impact the transition for rural hospitals at the same time that unique challenges
exist for small, rural facilities. To help frame the discussion, Summit participants
began by reviewing the driving forces and challenges related to engaging rural
providers in the value-based models. Although each rural hospital and community
has its own unique combination of opportunities and challenges, the figure below
summarizes the common themes identified for provider engagement (Figure 2).
Figure 2
Market Driving Forces and Transition Challenges
NATIONAL RURAL HEALTH RESOURCE CENTER 10
RURAL PROVIDER ENGAGEMENT STRATEGIES TO TRANSITION TO
VALUE
Summit participants brainstormed, grouped and prioritized a wide variety of
strategies to help guide rural providers in understanding the movement to value.
The top five strategies, in priority order, follow:
1. Create a shared vision of value and understand the role of
providers in the transition
Hospital leaders need to be willing to invest time and resources to help
provide education on the changing health care environment, and facilitate
discussions that lead toward a shared vision of value: improve health,
smarter spending and better care. Providers, particularly, primary care
physicians, need to be a key part of the discussion from the start as they will
be the drivers and conveners of care in this transition towards value.
It is recommended for providers of all types to communicate challenges,
strengths and opportunities with hospital administration to work together for
success in this changing environment.
2. Examine various models and approaches towards value
Hospital leaders should actively seek funding opportunities and resources to
support development and implementation of value-based strategies and
engage providers in determining the most feasible model to addresses the
unique needs of their community. The Center for Medicare and Medicaid
Innovation (CMMI) supported programs such as the ACO Investment Model
(AIM), and in many parts of the country State Innovation Model (SIM)
implementation provide low-risk funding as a learning ground to test
strategies and programs. Other opportunities may include local foundations,
health plans, HRSA – FORHP funding (Health Resources and Services
Administration Federal Office of Rural Health Policy) and Grants.gov. The
Rural Health Information Hub (RHIhub) is an excellent source for
identification of funding opportunities, ideas and information to support
development of funding applications. Hospital leaders may also want to
encourage providers to participate in technical assistance programs available
such as the Transforming Clinical Practice Initiative through joining a Practice
Transformation Network or the Comprehensive Primary Care Plus model.
Participating in educational webinars, conferences and networking
“This is something that has to start and grow – it’s not
going to happen overnight. We all have to own it.”
NATIONAL RURAL HEALTH RESOURCE CENTER 11
opportunities with other organizations and associations to glean best practice
examples may also be advantageous.
3. Invest in provider leadership (time, money and education)
Investment in provider leadership goes beyond financial reimbursement.
Every practice has a thought leader(s); work to identify their interests and
passions and identify ways to develop and align those pursuits with a shared
vision of value.
For example, supporting attendance at conferences that focus on the
changing health care environment, fostering development of skills related to
team-based care and providing opportunities to network with other provider
leaders are all means to investing in provider engagement that go above and
beyond paying for their time. Hospital leaders will be well served by investing
time in developing trusting relationships with providers, listening to and
acting on needs, challenges and suggestions when appropriate, and
supporting meaningful opportunities for participation in hospital governance.
4. Partner with others to capture and share data
Several Summit participants shared stories relating to the critical role of
capturing and sharing data to engage providers. Access to claims data that
providers gain when joining an ACO has been cited as eye-opening, since it
provides a fuller picture of the scope and costs of services their patients
receive.
Data can provide the platform for discussions on how to improve care and
lower costs, but for that to happen it needs to be shared frequently and
broadly, not just with providers, but with all staff that provide patient care.
Data should be shared as appropriate with other community providers
“An employed physician does not equal an engaged
physician”
“You have to share data shamelessly with everyone –
even the public”
“Data provides the platform for the discussions on how
to improve care”
NATIONAL RURAL HEALTH RESOURCE CENTER 12
including aging services, behavioral health, emergency medical services,
public health and social services. Key data for rural hospital to collect include,
but are not limited to: Medicare Beneficiary Quality Improvement Program
(patient safety, patient engagement, care transitions, outpatient care),
Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS), meaningful use of electronic health records, key financial
performance indicators, emergency medical needs, community health status
and needs. Fostering trusting relationships by sharing data can also support
improved communication and transitions of care processes across community
care team members.
5. Develop collaborative relationships and connect community
resources to address patient needs
There is growing recognition that many of the factors that impact illness and
health care spending are outside of the scope of traditional health care.
Mental and behavioral health needs, socio-economic factors and an
individual’s habits and behaviors all have significant impact on a patient’s
well-being and their ability to improve health or manage chronic illness. A
key component of value-based payment models is evaluation metrics that
measure the health of a population, thus it is becoming even more critical to
provide support and opportunities for providers to help address socio-
economic factors and lifestyle that negatively impact population health.
Strategies that include development of relationships and processes to easily
connect patients to community resources such as behavioral and/or social
service programs can not only help improve care for patients – but can also
help engage providers by allowing them a means to help address the non-
medical challenges that impact patient health and outcomes.
In addition to the top five strategies prioritized above, Summit participants
identified the following strategies (not prioritized) that may further support provider
engagement efforts:
6. Redesign operational processes for value and population health
A focus on improving efficiency and effectiveness in hospital processes can
set the stage for implementation of strategies that expand to include a focus
on value and improving community health. For example, use of Lean
“You have to listen to what people have to say – what are
their concerns, what are their ideas?”
NATIONAL RURAL HEALTH RESOURCE CENTER 13
methods can help eliminate waste, improve productivity and patient care.
Improvement teams that engage providers in a focus on quality and patient
safety can build capacity for success in new payment models, which typically
include a component related to performance on quality metrics.
7. Develop skills and organizational capacity for team-based care
Defining roles and distributing tasks across team members to reflect skills,
abilities and credentials can increase the ability of providers to improve care,
and can help reduce provider stress and frustration. In the Implementation
Guide for developing Continuous and Team-Based Healing Relationships, the
Safety Net Medical Home Initiative highlights the need to establish
organizational support for care delivery teams accountable for the patient
population as a critical step of transforming care. Patient needs are often
best met by a team of health care professionals working together to address
the medical and behavioral health needs of patients while addressing socio-
economic issues that may exacerbate health issues. Patients also should be
supported in helping to manage their own chronic illnesses and stress levels
which have a major impact on patient outcomes.
8. Seek opportunities for collaboration and synergy with other
providers and organizations
Identify and participate in rural networks, membership organizations or other
affiliations that offer opportunities to interact with other professionals facing
similar challenges. Networks and affiliations can provide opportunities to
share resources and implement strategies that may not be feasible by an
individual organization, and can help aggregate patients, and address
technology or support needs for participating in alternative payment models.
Nearly all the success stories shared by participants during the Summit
included some aspect of banding together to help support leadership and
improve health care access and value. This may include bringing together
providers across multiple organizations and/or communities to discuss
strategies and challenges. Providers who coordinate, communicate and
network effectively with one another demonstrate greater strength and
vitality within their rural organization and community as new insights are
gleaned, evidenced-based strategies are discussed or purchasing power is
combined.
“We need to get to ‘our patient’ not ‘my patient’.”
NATIONAL RURAL HEALTH RESOURCE CENTER 14
9. Tell your story
Open sharing of successes and challenges can support engagement at a
provider and community level, as well as encourage and inspire other rural
hospitals and providers and help influence policy and rulemaking. Seek
opportunities to regularly share information about your organization’s value
related activities with providers, local media, community groups and at local,
state and national conferences.
10. Advocate for rural payment policies that adequately address rural
community needs
Policies and regulations that impact care delivery and reimbursement are
undergoing significant change as federal and state programs shift to value-
based models. Ask providers for their input, and help be a voice for their
thoughts and concerns. Get to know your local legislators and congressional
representatives, invite them to your facility to see and hear about the impact
their policy decisions can have.
It is critical for rural voices to be advocating for policies that make sense,
and submitting formal comments about the impact of new regulations on
rural health care organizations. Participation in advocacy organizations such
as national and state associations or professional organizations such state
hospital or provider associations can be avenues to provide input into
healthcare policies and regulations. FORHP is also charged with advising
other HHS Agencies in regards to the impact of policy and regulations on
rural providers and communities. FORHP keeps a current list of rural related
policy announcements, with weekly updates.
RURAL EXAMPLES OF TRANSITION TO VALUE
Success Stories and Lessons Learned Shared by Summit Panelists
Create and promote a shared vision toward value
Health Care Collaborative (HCC) of Rural Missouri, a network of Federally Qualified
Health Clinics (FQHCs) has served as a platform for discussion regarding what is
best for the health of their local community, and a structure for collective action to
“Where are the cinders that you blow on to make the
fire happen?”
NATIONAL RURAL HEALTH RESOURCE CENTER 15
address needs. Although competition still exists, the network has allowed local
hospitals leaders a forum for exploring opportunities to increase value, without
having to shoulder all of the risk. For example, recognizing a lack of capacity to
serve behavioral health needs, the HCC Network was able to hire a psychiatrist and
lease services back to the local hospitals in addition to increasing access at the
FQHC clinic sites - something none of the organizations would have been able to do
on their own.
Invest in Provider Leadership
Caravan Health (formerly the National Rural ACO) works with more than 14,000
rural providers. A medical director has been selected for each of their 23 ACOs. At a
recent event focused on provider leadership across the organization, instead of
scheduling formal educational sessions, they brought them together with no formal
agenda, but rather had in-person discussions focused on the topics they wanted to
address – fears, obstacles, and successes. Just getting leaders together can be an
effective means of empowerment and providing education.
Seek out and take advantage of opportunities that offer funding to
support transformation
The Michigan Center for Rural Health, which provides leadership for two Medicare
ACOs in rural Michigan, cites the AIM funding (ACO Investment Model) from CMS as
transformational for the 17 communities involved. One of the most rewarding
aspects has been seeing people begin to think differently about how they deliver
care. Many recognized the need for change, but needed a push to get them started.
Taking advantage of the AIM opportunity has been viewed like a ‘scholarship’ to
support learning how to operate in the value-based models that are coming.
Capture and share data
Aledade uses ACO data from CMS with their affiliated practices to better understand
where patients are seeking care, what patients are at highest risk, prioritization for
chronic care management, and understanding costs. Access to the CMS data gives
providers and opportunity to get a handle around what is valuable – or not. For
example, in West Virginia Aledade used the CMS ACO data to profile cost and
quality of different cardiology groups, and provided that information to their
primary care providers. Rather than tell physicians which cardiology groups to use –
they gave them information that wasn’t previously available to help them make
their decisions about referrals.
NATIONAL RURAL HEALTH RESOURCE CENTER 16
Develop relationships and connect community resources to address
patient needs
Like many Critical Access Hospitals, Jefferson Healthcare in Port Townsend
Washington, was challenged with access to mental health services in their rural
community. Primary care and mental health services were in silos, and the local
community mental health agency had struggled with frequent staff and leadership
turnover. Nearly two years ago, hospital leadership approached the board of the
mental health agency and asked to be involved in the selection process of the new
Executive Director, sending a message of partnership, leadership support, and
potential financial resources through possible shared services. They have since
hired a shared psychiatrist position, and have worked towards integration of
services and the ability to fast track patient identified at highest risk into
appropriate services. The partnership has been so successful they are currently
recruiting for a second shared provider.
RURAL PROVIDER LEADERSHIP: TOOLS AND RESOURCES
At the end of the Summit, participants considered the provider engagement
strategies for rural hospitals in the transition to value and identified existing and
future resources for rural hospitals to deploy to support the implementation of
these strategies. The broad list of resources identified by participants is included in
Appendix B. A number of federally supported programs, technical assistance
programs and tools were identified that are responding to the transition to value
and relate to provider engagement. In addition a variety of associations and
training programs were recommended. Finally, the participants discussed
recommended resources to provide better support to rural hospitals. These
recommended resources could be supported or created by state Flex programs,
State Offices of Rural Health, rural health networks, technical assistance providers,
policy makers and funding agencies to provide better support to rural hospitals.
CONCLUSION
Rural health providers, particularly those in primary care will be at the heart of the
new value-based purchasing and population health management systems. Summit
panelists identified key strategies to help critical access hospitals, health networks
and Flex programs focus their efforts on provider engagement and help lead their
communities towards improved health, better health care and smarter spending.
NATIONAL RURAL HEALTH RESOURCE CENTER 17
APPENDIX A: SUMMIT PARTICIPANTS
John Barnas
Michigan Center for Rural Health [email protected]
517-432-9216
Barbara Berner University of Alaska Anchorage
School of Nursing [email protected]
907-786-4571
Ray Christensen, MD University of Minnesota Duluth
Gateway Family Health Clinic [email protected]
218-726-7318
Morgan Fowler Marcum & Wallace Memorial Hospital
[email protected] 859-625-8060
Kathy Johnson Dynamic Advantage [email protected]
320-226-6560
Paul Kleeberg, MD
Aledade [email protected] 612-655-8238
Paul Krause, MD Caravan Health
[email protected] 916-542-4718
Leslie Marsh Lexington Regional Medical Center [email protected]
308-324-5651, ext. 302
Joe Mattern, MD
Washington Rural Health Collaborative Jefferson Healthcare
[email protected] 360-379-8031
Mike McNeely
Health Resources and Services Administration
Federal Office of Rural Health Policy (FORHP) [email protected]
301-443-5812
Melinda Merrell
South Carolina Office of Rural Health [email protected] 803-454-3850, ext. 2025
Toniann Richard Health Care Collaborative of
Rural Missouri [email protected] 816-249-1529
Maggie Sauer Foundation for Health Leadership and
Innovation [email protected] 919-821-0485
Karla Weng Stratis Health
[email protected] 952-853-8570
Gary Wingrove Mayo Clinic Medical Transport [email protected]
202-695-3911
NATIONAL RURAL HEALTH RESOURCE CENTER 1
Center Staff Participants
Sally Buck
National Rural Health Resource Center
218-216-7025
Kami Norland
National Rural Health Resource Center
218-216-7023
Tracy Morton
National Rural Health Resource Center
218-216-7027
NATIONAL RURAL HEALTH RESOURCE CENTER 2
APPENDIX B: RURAL PROVIDER LEADERSHIP TOOLS AND
RESOURCES
Existing Resources
The following are suggested resources from the participants that are currently
available to support rural hospitals in implementing the key strategies in provider
engagement. The list includes federally supported tools and resources.
Agency for Healthcare Research and Quality – quality measurement tools
and resources for health care providers professionals
American Academy of Family Physicians
American Hospital Association – education forum
Baldrige Performance Excellence Criteria
City level data
Claims data
Clinic assessment (e.g. Colorado Rural Health Center tool)
CMS Innovation Center
o ACO Investment Model (AIM),
o Transforming Clinical Practices (TCPI)
o Comprehensive Primary Care Plus (CPC+)
County health rankings and roadmaps
Community collaboration integration between primary care and public
health (Practical Playbook)
Communitycommons.org
Community Paramedic (program handbook and college access to the
curriculum)
Community Paramedicine Insights Forum (archived streaming video of US
only CP programs)
Critical Access Hospital Financial Pro Forma tool
Federal Office of Rural Health Policy, Rural Health Network grants
Flex Monitoring Team
Health information exchange and associated electronic tools
Institute for Healthcare Improvement - team delivery model and
leadership
International Roundtable on Community Paramedicine
Johns Hopkins trainings
LEAP-Learning from Effective Ambulatory Practices
Medicare Beneficiary Quality Improvement Program (MBQIP)
National Quality Forum - quality measures
National Conference of State Legislatures
National Rural Health Association
NATIONAL RURAL HEALTH RESOURCE CENTER 3
Network development – National Cooperative of Health Networks
Association and Rural Health Innovations – Network Technical Assistance
Physician leadership programs
Population Health Portal
Quality Health Indicators (QHi)
Resiliency training
Rural Health Models and Innovations and Rural Health Value - profiles of
innovation
Rural Health Information Hub
Rural Health Value
Small Rural Hospital Transitions Project
Stanford Medicine Self-Management Program for chronic diseases
State Rural Health Associations
State Offices of Rural Health (SORH)
The Florence Prescription book and culture change challenge
Technical Assistance and Services Center for the Medicare Rural Hospital
Flexibility Program
Training for care coordination and health coaches – rural model
Needed Resources
These resources were identified by the participants to provide better support to
rural hospitals with provider engagement in the transition to value. They could be
supported or created by state Flex programs, State Offices of Rural Health, rural
health networks, technical assistance providers, policy makers and funding agencies
to provide better support to rural hospitals.
Access to claims data (currently only available with ACO participation for
Medicare FFS)
Affordable leadership coaching
Best practice maps for successes
Common data platform to share data
Cost modeling/ROI resource
Data repository and analysts
Education focusing on leadership skills
List of existing rural ACOs with a basic summary of where they are on
their journey
New funding sources
Patient and caregiver involvement in the change to value
Portal to share best practices
Rural Physician Leadership Training (Promote team participation, Follow-
up following team training, Over 1-2 years, Data/quality, Community)
NATIONAL RURAL HEALTH RESOURCE CENTER 4
SRHT project expansion
Strategies for engagement of civic/faith organizations
Truly inter-operable health records for data sharing
Training on using data (at pop. Level)
